How to Choose a Quality Hospice (and Spot the Warning Signs)

The hospice decision usually gets made in a hospital hallway, in about a day, by a family that has never made it before. The hospital hands you a list, everyone is exhausted, and you pick the name someone said first. Here’s how to make that choice well anyway — in about twenty minutes, with the one rating that matters, the questions that separate good from bad, and the warning signs that mean walk away.

Nobody teaches you how to choose a hospice — it’s a decision most people make exactly once, at the worst possible moment. If you’re still deciding whether hospice is the right kind of care at all, start with what hospice actually covers, and why timing is everything →. This page assumes the decision is made, and the question is which one.

First: you get to choose, and you can switch

Two rights almost no family knows they have.

The choice is yours. The hospital, the nursing home, or the doctor may hand you one name — sometimes because it’s genuinely good, sometimes because it’s affiliated, sometimes because it’s simply the name they always say. You are entitled to choose any Medicare-certified hospice serving your area, and a good discharge planner will hand you a list, not a single name. It is completely normal to interview two or three before signing — the questions below are built for exactly that.

And the choice isn’t a trap. If the hospice you picked isn’t delivering, Medicare allows you to transfer to a different hospice once per benefit period. You’re never locked in with a team that isn’t showing up. Knowing that on day one changes how the whole conversation feels.

The twenty-minute check: the Medicare Care Compare hospice search

Medicare publishes real quality data on nearly every hospice in the country, and almost no family looks at it. Here’s the walkthrough:

• Go to Medicare.gov/care-compare, choose Hospice, and enter your parent’s ZIP code.
• Look at the star rating first. Medicare publishes exactly one star rating for hospices — the Family Caregiver Survey Rating, from 1 to 5 stars. It isn’t a bureaucrat’s opinion: it’s built from a national survey (called CAHPS) completed by family caregivers after a death, covering how well the hospice communicated, responded when help was needed, treated the patient with respect, managed pain and symptoms, and supported the family emotionally and spiritually. Hospice star ratings compare each hospice against others nationwide — 4 and 5 stars are above average.
• Then find the plainest number on the page: the percentage of family caregivers who would definitely recommend this hospice. It’s the closest thing to asking a hundred families who lived it, “would you send your own mother here?”
• Scan the individual measures. Getting timely help and help for pain and symptoms are the two that predict what your 2 a.m. will look like. Care Compare also shows care patterns from Medicare claims — including how often patients were visited in their final days.

Three honest caveats, so the tool doesn’t mislead you. A missing star rating is not automatically a bad sign — a hospice needs at least 75 completed family surveys in the reporting window to get one, so smaller and newer hospices often show none; that’s a reason to ask more questions in person, not to cross them off. The data lags — scores reflect care from roughly the past one to two years, not last month. And the underlying measurement system was overhauled in October 2025 (a new real-time assessment tool called HOPE replaced the old checklist system), so the newest generation of quality data is still rolling onto the site through 2026 refreshes. Use Care Compare as your first filter — then verify with your own eyes and the questions below.

The signal nobody puts on a billboard: who owns it

Hospices don’t advertise their ownership structure, but it’s worth knowing: research by RAND found that a substantially higher proportion of for-profit hospices landed in the low-performing category than nonprofit hospices — across every quality measure studied.

Handle that finding like an adult, because it isn’t a verdict. There are excellent for-profit hospices and mediocre nonprofits, and the team that actually walks through your door matters more than the tax status of the company behind them. But as a screening signal when you’re choosing between strangers, ownership is fair information — and it’s a completely fair question: “Are you for-profit or nonprofit, and who owns the company?” It’s public information. A quality hospice answers instantly. Hesitation on that question is itself an answer.

Why the vetting matters right now

I spent thirteen years inside hospice referral, and I’ll say this plainly: most hospice teams are extraordinary people doing sacred work. And the industry currently has a genuine quality-and-fraud problem at its edges, which is exactly why a twenty-minute vetting matters.

The numbers, from the government’s own watchdogs: a federal Office of Inspector General review found about 20% of hospices had deficiencies serious enough to pose safety risks to patients. Congress responded by ordering Medicare to create a Special Focus Program — a public list of the poorest-performing hospices placed under intensified oversight. You may see that program mentioned in news coverage, so here’s its honest status: CMS published an initial list of 50 hospices, the program was challenged in court by industry groups, and as of February 2025 its implementation is paused while CMS re-evaluates it. In other words: the watchlist exists on paper, but you can’t currently rely on it as a live shopping tool.

What is live: in May 2026, CMS froze enrollment of new hospice and home health agencies into Medicare for six months — a direct response to fraud concentrated among fast-multiplying new agencies in several states. The cleanup is real and ongoing. Until it’s done, the twenty minutes of vetting on this page is your family’s actual protection — and it’s more than most referral sources will do on your behalf.

The questions to ask a hospice — before you sign

Interview the hospice the way you’d interview someone you were hiring to care for your mother — because that is literally what’s happening. The full printable list is below; here are the ones that do the most work, and why:

• “What will the first week look like, day by day?” A quality hospice answers specifically: admission visit, nurse visits on these days, aide this often, social worker within this window. Vagueness here predicts vagueness later.
• “Who answers at 2 a.m. — and how fast can someone be at the bedside?” The entire value of hospice is tested at night. You want a nurse on the phone within minutes and a clear answer about when someone comes to the house.
• “If her symptoms spiral at home, can you provide continuous care here?” Medicare hospice includes crisis-level care — continuous nursing at home, and inpatient care when symptoms can’t be managed at home. Every hospice must provide access to all levels; ask how they actually do it and where their inpatient beds are.
• “What exactly will our family be expected to do — and will you teach us?” Between visits, family does most of the hands-on care. The good ones train you: medications, turning, bathing. The bad ones leave you to figure it out at midnight.
• “How do we use the respite benefit?” Medicare’s hospice benefit includes up to five days of inpatient respite so the caregiver can rest — one of the most under-used benefits in all of Medicare →. A hospice that explains it unprompted is telling you who they are.
• “What is your star rating — and would you show us your survey results?” You already looked it up. Now watch whether they’re straight with you.

Hospice red flags: walk away

Most hospices won’t trip any of these. When one does, believe it:

• Pressure to sign today. Real urgency exists in hospice — but a quality provider creates clarity under pressure, not panic. “This offer requires enrolling now” is sales, not care.
• They recruited you. If a “hospice” found you — cold calls, door-knocks, offers of free housekeeping or groceries for signing up, when no doctor referred them — walk away and hang onto your Medicare number. Recruiting people who aren’t dying is the signature move of hospice fraud, and it’s the pattern behind the federal crackdown.
• Vagueness about visit frequency. “We’ll be there whenever you need us” is not a schedule. Good hospices commit to specifics.
• Evasion on ownership or references. Both are questions honest organizations answer in one sentence.
• No 24/7 nurse line answered by a clinician. An answering service that “takes a message” fails the only test that matters.
• Paperwork they won’t explain. Electing hospice changes how Medicare pays for care related to the terminal illness. A quality hospice explains exactly what you’re signing. Never sign what hasn’t been explained.

If you chose wrong

It happens, and it is fixable. First, call the hospice and ask for the supervisor or director — care teams can be changed, schedules adjusted, and a good organization fixes problems fast when named plainly. If it doesn’t improve: you can transfer to another hospice (once per benefit period, and the new hospice handles the paperwork), and you can file a complaint with 1-800-MEDICARE or your state’s health department survey agency — complaints are how bad actors eventually get caught. And if what’s really happening is that the whole approach no longer matches what she wants, you can revoke hospice entirely and return to standard Medicare treatment. None of these doors lock behind you.

One last thing, because thirteen years taught me it’s the thing families regret most: whichever hospice you choose works best when her wishes are already in writing. If the advance directive and health care proxy aren’t done, do them now — hospice teams honor documents, not guesses →.

Questions families ask

How do I choose a good hospice?

Choose a hospice by checking its Medicare star rating and “would recommend” percentage on Medicare’s Care Compare website, then interviewing at least two providers with specific questions about the first week of care, nighttime response, visit frequency, and family training. You have the right to choose any Medicare-certified hospice regardless of which one the hospital recommends, and Medicare allows you to switch hospices if your first choice isn’t delivering.

What is a good hospice star rating?

A rating of 4 or 5 stars is above average — Medicare’s hospice star rating (the Family Caregiver Survey Rating) compares each hospice against others nationwide based on surveys of family caregivers after a death. A missing rating is not automatically a bad sign, because a hospice needs at least 75 completed family surveys in the reporting period to receive one, so small and new hospices often have none; in that case, rely more heavily on the interview questions.

What questions should I ask a hospice before choosing?

The highest-value questions to ask a hospice are: what the first week will look like day by day; who answers at 2 a.m. and how fast someone can come to the bedside; how often the nurse visits and whether that increases near the end; whether they can provide continuous care at home in a crisis and which inpatient facility they use; what the family will be expected to do and whether they teach hands-on skills; and whether they’re for-profit or nonprofit. A quality hospice answers all of these specifically and without hesitation.

What are the red flags of a bad hospice?

The biggest hospice red flags are pressure to enroll immediately, vagueness about how often staff will visit, evasion when asked about ownership or references, the absence of a 24/7 line answered by a nurse, and — most seriously — a hospice that recruited you through cold calls, door-knocking, or offers of free services when no doctor referred them, which is the signature pattern of hospice fraud. If something feels rushed or unclear, pausing to interview another provider is always allowed.

Can I switch to a different hospice?

Yes — Medicare allows a patient to transfer from one hospice to another once per benefit period, and the new hospice handles the transfer paperwork. You can also raise problems with the current hospice’s director first, file a complaint with 1-800-MEDICARE or your state survey agency, or revoke hospice entirely and return to standard Medicare treatment. Choosing a hospice never locks you in.

Are for-profit hospices worse than nonprofit hospices?

Not automatically, but research by RAND found that a substantially higher proportion of for-profit hospices fell into the low-performing category than nonprofits across the quality measures studied — so ownership is a reasonable screening signal, not a verdict. There are excellent for-profit hospices and weak nonprofits; asking “are you for-profit or nonprofit, and who owns the company?” and watching how directly they answer tells you as much as the answer itself.

Last verified: 19 August 2026 against CMS Care Compare materials, CAHPS Hospice Survey public reporting documentation, and CMS program announcements · Next review: January 2027

This page is educational and is not medical, legal, or financial advice. Mark Duda is not a physician, a nurse, or an attorney. Hospice election has real consequences for how Medicare pays for care — discuss the decision with her doctor, and verify any program detail with Medicare (1-800-MEDICARE) or the hospice directly, as rules and oversight programs change. See our disclaimers.